How ENGAGE’s Community Learning Shapes Stroke Recovery
ENGAGE focuses on the social side of stroke recovery, helping people rebuild confidence and reconnect with their communities. This community-based group intervention was tested by a multi-university team of researchers led by Dr. Elizabeth Skidmore at the University of Pittsburgh’s Department of Occupational Therapy.
The goal of the ENGAGE intervention, which was co-designed by community members who are stroke survivors, occupational therapy practitioners, and rehabilitation scientists, is to improve the recovery process so people can identify meaningful community and social participation goals, develop strategies to achieve them, and return to their daily lives. Re-engaging in community activities is difficult, even after physical and neurological recovery.
“This was a really transformational project,” said Skidmore, “it focuses on real challenges with lived experiences in the community. We saw community members navigate around barriers and realize their goals, which is the reason I became an occupational therapist.” A stroke is a medical emergency where blood flow in the brain is disrupted, resulting in oxygen and nutrients not reaching the brain.
The team published their pilot study, Promoting community and social participation in chronic stroke: A pilot study of the ENGAGE intervention, in October 2025. This collaborative research, which was funded by the National Institutes of Health (NIH), describes the overall feasibility of the ENGAGE intervention, including retention, engagement, acceptability, satisfaction, and safety.
Additional University of Pittsburgh co-authors and researchers were Kelsey Voltz-Poremba, and Tina Harris. The pilot study was completed in collaboration with researchers from the Washington University School of Medicine Program in Occupational Therapy, the University of Minnesota School of Kinesiology College of Education and Human Development, and the University of Illinois Chicago College of Applied Health Sciences Department of Occupational Therapy.
Collaboration Is at the Heart of ENGAGE
ENGAGE seeks to empower people who have experienced a stroke to feel confident in their everyday lives, gain autonomy, and engage with others in the community. “Talking about shopping is one thing; doing it in the real world is another, especially when you’re navigating transit schedules or the steep hills of Pittsburgh,” said Skidmore.
The “first ingredient” of ENGAGE’s 6-week program and 12 sessions, Skidmore said, is participant selected goals by completing an activity card sort of 55 common community and social activities. This interactive card sort method was co-developed by co-author, Dr. Carolyn Baum, from the Washington University School of Medicine Program in Occupational Therapy. This process allows ENGAGE facilitators to understand both participants’ goals and to then use a guided discovery process to help participants think about practical steps that they can take to achieve their goals. These practical steps are practiced in three individual and three group outings that align with their personal goals.
A core element of ENGAGE is that it is co-facilitated by community members who have experienced a stroke, who act as peer mentors, alongside an occupational therapy provider, both trained in the ENGAGE intervention. Over the course of the 12 sessions, participants apply learning related to a variety of community and social participation topics, including understanding community and social participation plans, advocating for self and others, and engaging in the community. (See the full list in Table 1 in Skidmore et al., 2026). The sessions focus on the ENGAGE intervention’s essential elements, which are social learning, guided problem solving, and skilled practice in engaging in community outings.
At the conclusion of ENGAGE’s pilot 12 sessions, in which 90% (27 of 30) of participating community members completed, there were no safety concerns. A majority of participants indicated high satisfaction with the program, and all achieved the group’s goals and at least one of their individual goals, which included starting a food truck business, going horseback riding, and engaging in photography.
Community Connectors Are “Getting the Word Out”
Co-designing programs with people recovering from stroke is essential, so community members can share their perspectives and observations of social and physical challenges and what would be helpful for them.
This lived experience provides occupational therapists with specific and real-world insight on how they can help people rehabilitating after a stroke based on what worked and what needs improvement in the outings. “There are things that are solvable, if you think about it the right way,” said Skidmore.
Tina Harris, a social worker, patient advocate, and one of the peer mentors and ENGAGE facilitators, was key to building this network, said Skidmore. As a Community Outreach Ambassador in the University of Pittsburgh School of Health and Rehabilitation Sciences and “Stroke Thriver”, Harris has a personal understanding of the real-life challenges that people face after experiencing a stroke, including those related to regaining independence.
Harris, Skidmore, and the ENGAGE team worked together to set up the program, which they mapped out together in Chicago. During the design process of ENGAGE, Harris provided input on what participants would be interested in. When ENGAGE was piloted, Harris then helped to build community, acting as the “glue” in the program, said Skidmore.
Harris’s message, as a patient advocate and ENGAGE facilitator, to those supporting victims of stroke is, “Treat others as you want to be treated.” Harris is driven to help others and seeks to “get the word out” for what it's like to experience a stroke and aphasia, the latter of which affects the ability to communicate and can occur when blood flow to the brain is interrupted during a stroke.
For the ENGAGE participants in the Washington University cohort, Sular Gordon, Patient Stakeholder and External Advisory Board, from the Washington University School of Medicine Program in Occupational Therapy, provided this essential community-building role.
Solving Problems Together Builds Community Bonds
Social learning and collaborative problem solving are core elements of ENGAGE. Each group works together through the process to identify ideas that meet their various interests, problem-solve logistics for all the real-world details, and go on three community outings, which are supervised by occupational therapists who provide support, but do not lead the group, Skidmore said.
The groups are free to creatively design their community outings based on participants’ real interests, goals, and passions. For example, by blending interests in gardening, walking, and photography, the group decided to go to a botanical garden in Pittsburgh. Other outings were to restaurants, community volunteer events, museums, and health events/walks.
As a result of the social learning process and community outings in the ENGAGE pilot, participants became more confident and empowered to find solutions. This included asking for what they needed and helping others. For example, Skidmore shared that participants asked if they could change the way they could get food at a buffet during a group outing. Community support was essential. “Understanding they can ask for help, for themselves or others in the group showed self-awareness and self-management, both of which are goals of the ENGAGE intervention,” said Skidmore.
Continued ENGAGEment
The strong bonds developed between participants during the ENGAGE pilot are holding. Skidmore shared that participants established their own social media group continue to regularly meet up with each other to go on outings.
“They found their people through ENGAGE, and that’s so important,” said Harris.
Related to applications or use of ENGAGE, Skidmore reported that there was very organic growth in both cities where ENGAGE was piloted, and shared that she could see ENGAGE embedded in a community-based program. Ongoing work for ENGAGE, after this pilot study, is to test it in a randomized control trial, which is a larger-scale efficacy study. Future studies will also provide an opportunity to investigate ENGAGE’s impact on long-term health and well-being.
Reflecting on why occupational therapy research is important and her commitment to the field, Skidmore said, “We needed to know more about why one intervention is better than others when making decisions, including understanding both controlled and uncontrolled circumstances and environments.” Skidmore has also co-authored studies on adapting ENGAGE to be used during rehabilitation after other life-changing health events, such as traumatic brain injury.
Participants shared powerful reflections and reframed their visions of the future as a result of the ENGAGE experience, such as knowing they can ask for help, call places in advance, ask questions, use low-cost transportation systems, and access resources. “Most importantly, they gained an understanding that they are not alone,” said Skidmore.